Psychosocial Determinants of Sleep Behavior and Healthy Sleep Among Adolescents: A Two-Wave Panel Study

To date, it remains unknown which psychosocial determinants identified by several leading behavior change theories are associated with different sleep parameters among adolescents. Therefore, this study investigates whether changes in knowledge about healthy sleep, attitude toward healthy sleep and going to bed on time, self-efficacy to engage in healthy sleep behavior, perceived parental and peer norms, perceived barriers (e.g., worrying, fear of missing out), and perceived support (e.g., bedtime rules, encouragement) related to healthy sleep are associated with changes in adolescents' sleep duration on school days and free days and sleep quality over a period of 1 year. Two-wave data of 1648 Flemish adolescents (mean age = 15.01, SD = 0.65, 46.3% female) were analyzed using linear models. Increased levels of parental social support, positive attitude towards and perceived advantages of healthy sleep, norm-knowledge, and perceived peer behavior were associated with sleep duration, with parental social support having the strongest association. Increased levels of perceived barriers were associated with decreased levels of sleep quality parameters, and increased levels of self-efficacy, positive attitude, and parental modeling were associated with improved sleep quality parameters, with perceived barriers having the strongest association. The current results indicate that behavior change theories are useful in the context of adolescent sleep behavior and suggest that perceived parental support (i.e., bedtime rules) and perceived barriers are most strongly associated with adolescents' sleep duration and/or quality.

Does sleep relate to next-day cannabis use during treatment? Findings from an adolescent and young adult motivational enhancement and cognitive behavioral therapy plus topiramate intervention

BACKGROUND

Interventions for youth cannabis use have limited efficacy. Sleep is likely to affect treatment response, as sleep difficulties are cross-sectionally associated with use and common during treatment. This analysis examined how sleep duration and subjective trouble sleeping related to next-day cannabis use among youth during cannabis treatment.

METHOD

Participants (N=64) received a psychosocial intervention plus topiramate versus placebo while completing a 6-week ecological momentary assessment study. Time-varying effect modeling (TVEM) examined within- and between-person associations between sleep and cannabis use and how the strength of within-person associations varied over the course of treatment.

RESULTS

TVEM resvealed that, between-participants, youth with longer average sleep duration used cannabis less often controlling for baseline cannabis use, topiramate, and weekend status. Daily within-person fluctuations in sleep duration and trouble were not associated with use.

CONCLUSIONS

Findings suggest regularly shorter sleep may impede treatment outcomes. Adolescents who regularly have insufficient sleep durations likely need additional intervention to improve sleep difficulties in tandem with cannabis use reduction.

Sleeping Healthy, Living Healthy: Using Iterative, Participatory Processes to Develop and Adapt an Integrated Sleep Hygiene/Mind-Body Integrative Health Intervention for Urban Adolescents

Racial and ethnic minority adolescents living in urban settings experience sleep disparities. Few interventions have been developed to address these disparities. Guided by principles of participatory design and inclusion, our team developed a novel intervention that combined sleep hygiene education with mind-body integrative health (MBIH) practices to improve sleep quality among adolescents in New York City. The goal of this article is to describe our iterative development and design process, the final product, and future directions. Our participatory approach incorporated information from formative work with adolescents having lived experience, practitioners, and syntheses of published literature. The final intervention-Sleeping Healthy, Living Healthy-consists of six, 40-minute group sessions and one 20-minute individual session designed for high school students. Each session has a set of learning objectives, combining instruction, group activities, and discussions on sleep hygiene and MBIH topics. Our manualized intervention includes handouts created by a graphic design team that served as a review and reminder for home practice. We describe intervention implementation to two unique cohorts and detail our methods used to fine-tune the intervention between cohorts. Our partnership with and insights from both adolescents and practitioners serve as a guide for researchers aiming to use participatory methods to develop interventions to decrease health disparities in specific populations.

A Naturalistic Actigraphic Assessment of Changes in Adolescent Sleep, Light Exposure, and Activity Before and During COVID-19

The majority of high school-aged adolescents obtain less than the recommended amount of sleep per night, in part because of imposed early school start times. Utilizing a naturalistic design, the present study evaluated changes in objective measurements of sleep, light, and physical activity before (baseline) and during the first wave of the COVID-19 pandemic (during COVID-19) in a group of US adolescents. Sixteen adolescents (aged 15.9 ± 1.2 years, 68.8% female) wore an actigraphy monitor for 7 consecutive days during an in-person week of school before the pandemic (October 2018-February 2020) and again during the pandemic when instruction was performed virtually (May 2020). Delayed weekday sleep onset times of 1.66 ± 1.33 h (p < 0.001) and increased sleep duration of 1 ± 0.87 h (p < 0.001) were observed during COVID-19 compared with baseline. Average lux was significantly higher during COVID-19 compared with baseline (p < 0.001). Weekday physical activity parameters were not altered during COVID-19 compared with baseline, except for a delay in the midpoint of the least active 5 h (p value = 0.044). This analysis provides insight into how introducing flexibility into the traditional school schedule might influence sleep in adolescents.

Sleep’s role in the development and resolution of adolescent depression

Two adolescent mental health fields — sleep and depression — have advanced largely in parallel until about four years ago. Although sleep problems have been thought to be a symptom of adolescent depression, emerging evidence suggests that sleep difficulties arise before depression does. In this Review, we describe how the combination of adolescent sleep biology and psychology uniquely predispose adolescents to develop depression. We describe multiple pathways and contributors, including a delayed circadian rhythm, restricted sleep duration and greater opportunity for repetitive negative thinking while waiting for sleep. We match each contributor with evidence-based sleep interventions, including bright light therapy, exogenous melatonin and cognitive-behaviour therapy techniques. Such treatments improve sleep and alleviate depression symptoms, highlighting the utility of sleep treatment for comorbid disorders experienced by adolescents.

Sleep problems are both a symptom and precursor of adolescent depression. In this Review, Gradisar et al. describe how the combination of adolescent sleep biology and psychology predisposes adolescents to develop depression, and describe interventions that improve sleep and depression symptoms in this population.

Sleep disturbance and the long-term impact of early adversity

Sleep disturbance may be a central, yet underappreciated mechanism by which early adversity has a long-term impact upon mental and physical health. The fundamental regulatory processes shaped by early adversity - neural, neuroendocrine, and immune - are also central to sleep. Sleep problems, in turn, lead to a similar constellation of chronic health problems that have been linked to early adversity. We bring together work from the fields of early adversity and sleep in order to suggest a model by which sleep disturbance plays a critical role in the far-reaching impacts of early adversity on health. Future research should employ more longitudinal designs and pay particular attention to the impact of developmental periods such as adolescence and midlife when maturational and environmental factors conspire to create a unique time of sleep disturbance. We also suggesting that intervening to minimize sleep disturbance may be a promising means by which to test the model, as well as potentially blunt the long-term impact of early adversity on health.

Sleep-Wake Timings in Adolescence: Chronotype Development and Associations with Adjustment

Adolescent sleep research has focused heavily on duration and quality with less work examining chronotype, defined as individual differences in sleep-wake timings driven by the circadian rhythm. This study filled a gap in the literature by utilizing actigraphy-based sleep estimates in an accelerated longitudinal design in order to better understand the developmental trajectory and individual stability of chronotype during adolescence, as well as the associations between chronotype with risky behaviors, substance use, and depressive symptoms. A total of 329 adolescents (57% female; 21% Asian American, 31% European American, 41% Latino, 7% other ethnicity) provided actigraphy-based estimates of sleep and completed questionnaires at up to three time points, two years apart, beginning at 14-17 years of age. Multilevel modeling revealed a non-linear developmental trend in chronotype whereby eveningness increased from 14 to 19 years of age followed by a trend toward morningness. Individual differences in chronotype exhibited modest stability during adolescent development. Furthermore, greater evening chronotype was associated with more risky behaviors and substance use among males, and more substance use among older adolescents, whereas depressive symptoms were not associated with chronotype. The findings from this study may have practical implications for adolescent behavioral health interventions targeted at reducing risky behaviors and substance use among youth.

Within-person fluctuations in stressful life events, sleep, and anxiety and depression symptoms during adolescence: a multiwave prospective study

BACKGROUND

Adolescence is characterized by substantial changes in sleep behavior, heightened exposure to stressful life events (SLEs), and elevated risk for internalizing problems like anxiety and depression. Although SLEs are consistently associated with the onset of internalizing psychopathology, the mechanisms underlying this relationship remain poorly understood, especially at the within-person level. Here, we leverage a high-frequency longitudinal design to examine sleep as a potential mechanism linking SLEs to increases in anxiety and depression symptoms over a one-year period.

METHODS

Thirty female adolescents aged 15-17 years completed 12 monthly in-laboratory assessments of exposure to SLEs and symptoms of anxiety and depression (n = 355 monthly assessments), and wore an actigraphy wristband for continuous monitoring of sleep for the duration of the study (n = 6,824 sleep days). Multilevel models examined concurrent and lagged within-person associations between SLEs, sleep duration and timing regularity, and anxiety and depression symptoms.

RESULTS

Within-person fluctuations in SLEs were associated with variability in sleep duration both concurrently and prospectively, such that when adolescents experienced greater SLEs than was typical for them, they exhibited more variable sleep duration that same month as well as the following month. In turn, within-person increases in sleep duration variability predicted greater anxiety symptoms in the same month and mediated the association between SLEs and anxiety.

CONCLUSIONS

These findings highlight sleep disruptions as a mechanism underlying the longitudinal associations between SLEs and anxiety symptoms, and suggest that interventions promoting sleep schedule consistency may help mitigate risk for stress-related psychopathology in adolescence.

Impact of Cumulative Unhealthy Sleep Practices in Adolescence on Substance Use in Young Adulthood Estimated Using Marginal Structural Modeling

Objectives

The purpose of this study was to identify the impact of chronic, unhealthy sleep practices in adolescence on substance use in young adulthood. Unhealthy sleep practices in adolescent samples exhibit a bidirectional relationship with substance use. The relationship is further complicated if we consider that confounders such as depression vary over time and are often in response to adolescents’ prior poor sleep practice, which can be addressed by a counterfactual approach using a marginal structural model.

Methods

Data in this study are from the Taiwan Youth Project, a longitudinal study that started in 2000 and surveyed 2,690 7th grade students at age 13. Outcomes include frequency of cigarette smoking and alcohol drinking at age 21. Three unhealthy sleep practices were included in this study: short sleep, social jetlag, and sleep disturbance. We used a marginal structural model with stabilized inverse probability-of-treatment weights to address time-varying confounders in each wave and a total sample of 1,678 adolescents with complete information for this study.

Results

Accumulated waves of sleep disturbance and social jetlag in adolescence were significantly associated with cigarette use in young adulthood. Accumulated social jetlag but not sleep disturbance was also associated with alcohol use in adulthood. Accumulated waves of short sleep were not associated with later alcohol use, but were negatively correlated with cigarette use.

Conclusion

Interventions that aim to reduce the likelihood of substance use in young adulthood should consider confronting unhealthy sleep practices, in particular the discrepancy between bedtimes on school days and weekends and sleep disturbance.